Provider Demographics
NPI:1588829782
Name:DR. EVANS EXCLUSIVE HEALTH & WELLNESS
Entity Type:Organization
Organization Name:DR. EVANS EXCLUSIVE HEALTH & WELLNESS
Other - Org Name:EXCLUSIVE HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ATHALIE
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:210-900-6027
Mailing Address - Street 1:2313 LOCKHILL SELMA RD STE 240
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3007
Mailing Address - Country:US
Mailing Address - Phone:210-446-3097
Mailing Address - Fax:
Practice Address - Street 1:1000 E 41ST ST STE 915
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-4808
Practice Address - Country:US
Practice Address - Phone:210-900-6027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5925111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1598989618OtherNPI